US budget negotiations threaten global health spending

Millions of the world’s poorest people, especially children, could feel the pain of America’s belt-tightening.

Some foreign aid advocates argue that the Obama administration’s reform does not go far enough: in the eyes of these advocates, the proposal, which ensures that shipping of US food is at least 55 percent of the food aid budget, and thus does not maximize flexibility in providing aid.

Under the current system, developed in the 1950s as a way to offload surplus US harvests, America purchases grain, oil, and other products on domestic exchanges. The US then transports it on US flagged ships to hunger-afflicted regions. According to reports by the Government Accountability Office, this wastes around 50 percent of US spending on food aid, which goes to domestic agricultural and shipping industries. Many large aid groups have long advocated for a reform of this system, including CARE, Oxfam America, Partners in Health and ONE.

At the same time, other aid groups have a vested interest in the current process, particularly the part of the system known as “monetization.” Under this system, American aid groups that receive the food may sell off some of it in the afflicted region, in order to fund other development programs for which they don’t receive direct funding. Members of an advocacy group for organizations that want to maintain the current system, the Alliance for Global Food Security, include religious aid organizations like World Vision, the United Methodist Committee on Relief, and the Adventist Development & Relief Agency, International.

A 2011 GAO analysis found that this complicated process wastes about one-third of funds and can disrupt food local markets.

American agricultural and shipping companies that are proponents of the current system argue that the fact that the food aid program also supports American industry has helped ensure that Congress continues to fund it. If it were just another budget item, it could face cuts.

In a March 21 letter to congressional leaders, written more than two weeks before the administration had released its proposal to reform the program, dozens of trade associations representing corn, wheat, beef, oil, and other agricultural interests, a gaggle of domestic shipping companies, and various faith-based aid groups, wrote: “Growing, manufacturing, bagging, shipping, and transporting nutritious U.S. food creates jobs and economic activity here at home, provides support for our U.S. Merchant Marine, essential to our national defense sealift capability, and sustains a robust domestic constituency for these programs not easily replicated in alternative foreign aid programs.”

Their rhetoric appears to have been picked up by sympathetic members of Congress, who penned their own letter two weeks later: “The Food for Peace program has supported key American interests both domestically, by supporting American agriculture and our merchant marine, and internationally by providing food aid to impoverished countries in desperate need. Changes to this program will threaten all of the missions it has supported, including particularly the domestic sealift capacity on which our military depends.”

The letter was co-authored by Rep. Elijah Cummings (D-Md.) with Duncan Hunter (R-Calif.). Cummings received $51,000 in campaign donations from the shipping industry and $4,250 from agriculture industry in the 2012 election cycle, while Hunter received $31,500 from agricultural and $22,250 from shipping companies, according to an analysis for GlobalPost by the Center for Responsive Politics, a watchdog group.

The Impact of Negelect

Meanwhile, other less glamorous diseases are either fighting to maintain their funding or have scant attention. Malaria, which kills about 500,000 children a year, still struggles to get strong support, despite a highly praised US government program that has shown large gains in prevention and treatment. With budget pressures looming, many supporters were fearful of large cuts and galvanized support from the business community and philanthropies, which so far has paid off. But the current budget pressures mean that badly needed expansions into two countries, Nigeria and Democratic Republic of Congo, which account for more than 40 percent of all malaria deaths, probably will not happen soon. Even worse, if further cuts were to come it would reverse the current gains as people who have lost resistance were again exposed, said Dr Mickey Chopra, chief of health at UNICEF. Children would die, he said. “Epidemiologically and medically it would be a disaster.”

The current budget battles affect not only existing programs, but trust in the US as a reliable, long-term partner, said Greg Adams, Director of Aid Effectiveness at Oxfam. A successful global health strategy relies upon close working relationships with governments. The constant fluxuations from congressional budget wars undermines the US’ ability to operate, he says.

“You’re not just cutting off medications, you’re damaging trust, damaging relationships and throwing progress backwards because people can’t depend on the US as a reliable partner. … That has a really powerful impact in getting people to engage with us,” said Adams.

One of the leading causes of death for children also receives the least attention: diarrhea. Mundane, and preventable, as it is, it still causes 11 percent of all deaths in children, according to Dr. Chopra.

Diarrhea, said Dr. Chopra, “is a condition which no one should die of. No child should die of it because we have very cost effective ways of treating it.”